Do masks affect patient-doctor relationships?

Despite the protective benefit of mask-wearing in the face of the COVID-19 pandemic, it appears to have put a strain on one important thing: communication. A study suggests that surgeons who wore clear masks were perceived by patients as better communicators, more empathic, and drew more trust vs those wearing covered masks.

“Patients reported improved communication when surgeons donned a clear mask, suggesting that not seeing the surgeon’s face may [negatively impact] the patient-surgeon relationship,” said the researchers.

Fifteen surgeons wore either a clear or covered mask for each clinic visit with a new patient. Responses from 200 patients (n=100 each arm) were evaluated. [JAMA Surg 2021;156:372-378]

 

For patients: it’s about clarity, empathy, trust

More patients noted that surgeons wearing clear vs covered masks provided understandable explanations (95 percent vs 78 percent) and had knowledge of their medical history (100 percent vs 78 percent; p<0.001 for both).

“[M]any patients felt it was easier to hear when surgeons wore clear masks,” they explained. “[Covered masks may] lose many of the nonverbal cues, [whereas] clear masks allow for patients to read lips [and visualize] nonverbal facial expressions. This may explain the higher ratings expressed by patients in these two domains.”

Surgeons wearing clear masks were also perceived by more patients to be more empathic vs those wearing covered masks (99 percent vs 85 percent; p<0.001). “A significant portion of empathy is nonverbal, with facial expressions playing a key role in effective communication … Demonstrating empathy … improves patient satisfaction and leads to better outcomes,” they said.

A higher level of trust was also tied to surgeons wearing clear vs covered masks (94 percent vs 72 percent; p<0.001). “With diminished trust between patient and surgeon, any deviation from the expected result of an operation may lead to considerable frustration, accusations, and even litigation,” said the researchers.

Patients unanimously preferred clear over covered masks in terms of overall improved communication with their surgeon and facial visualization (100 percent vs 72 percent; p<0.001). “Overall, patient comments demonstrated an excitement for the clear mask, whereas covered masks were more often met with complaints.”

 

What surgeons say

Despite the overwhelming patient preference for the clear mask, surgeons’ responses appear to suggest otherwise – eight of them noted that clear masks were an unlikely choice for them in the future; four said they would only opt for these should patients voice their preference for it.

Apart from fit and fogging, appropriate protection was their primary concern. “While the clear masks’ protection rating is equivalent to standard covered masks, lack of confidence in their ability to provide protection would likely be a barrier in their use,” said the researchers.

 

Taking it at face value

As masks will remain a staple for some time, deliberate attention to preserve patient-doctor communication is warranted. “These findings should alert surgeons because patient perceptions may not be detectable without purposeful attention to communication,” said the researchers.

The impact of masks in this setting should be further explored to better understand their effect on communication. “[H]ealthcare workers must be aware of the barrier created by covering their face and find ways to overcome it,” they added.

 

The ‘how’ matters

For surgeons, a consultation may be a transaction or an information exchange platform. But for patients, the experience may be ‘relational’, said Drs Margaret Schwarze and Elle Kalbfell from the University of Wisconsin-Madison, Madison, Wisconsin, US, in a commentary. “[V]isual cues (ie, smile, frown, other facial gestures) likely contribute to patient-perceived rapport and higher ratings despite similar informational content.”

“The findings may also point to what covered masks lack rather than what clear masks provide,” they added. A covered mask inadvertently limits transparency and visual cues that may help facilitate communication effectively. “[H]ow we speak may be more important than what we say.”